Provider Demographics
NPI:1598395758
Name:TAYLOR, SOPHIA (PHARM D)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 KONERT HILL DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7176
Mailing Address - Country:US
Mailing Address - Phone:217-440-5262
Mailing Address - Fax:
Practice Address - Street 1:4700 N HANLEY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-2700
Practice Address - Country:US
Practice Address - Phone:866-997-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013022774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist